Bill To:


Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:


Jessani Mangho
3419 Kissman Drive
Austin, Texas 78728
Policy # 044089343


Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    1.5
    $525.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1.5
    $112.50
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 326 Safety Fest (# Used)

    $2.50
    5
    $12.50
  8. 407 Patient Care / Evaluation (Per Patient)

    $100.00
    1
    $100.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 81 and I-10 - Ponce De Leon, Florida

Subtotal $1,406.00
Total Due $1,406.00


Updated
March 23, 2021 @ 3:28 pm

Invoice updated by Geoffrey.

Status Update
March 23, 2021 @ 3:28 pm

Status changed: Draft to Pending.

Updated
November 19, 2021 @ 6:11 pm

Invoice updated by Geoffrey.

Updated
November 19, 2021 @ 6:12 pm

Invoice updated by Geoffrey.

Updated
November 19, 2021 @ 6:13 pm

Invoice updated by Geoffrey.

Updated
November 19, 2021 @ 6:13 pm

Invoice updated by Geoffrey.

Updated
November 19, 2021 @ 6:14 pm

Invoice updated by Geoffrey.